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General NPI Number Information
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NPI Number | 1275584831
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Entity Type | Organization
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Legal Business Name | PUTNAM FAMILY MEDICINE PC
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 2424 ROUTE 6 BREWSTER CARMEL PROF BLDG
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City | BREWSTER
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State | NY
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Zip | 10509-2527
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Country | US
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Telephone | 845-278-2720
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Fax |
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Provider Business Mailing Address
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Address Line | 2424 ROUTE 6 BREWSTER CARMEL PROF BLDG
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City | BREWSTER
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State | NY
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Zip | 10509-2527
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Country | US
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Telephone | 845-278-2720
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OFFICER
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Name | DR. MICHAEL J NESHEIWAT
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Credential | M.D.
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Telephone | 845-278-2720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 186733
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License Number State | NY
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